The medial head of the gastrocnemius is frequently injured during athletic events. A forceful plantar flexion of the foot, often with an extended knee, results in partial tear or rupture of the medial head of the gastrocnemius near its origin on the distal femur. This may be the result of a fall on a plantar-flexed foot or the sudden plantar flexion that occurs in the back leg of an athlete serving a tennis ball. Predisposing factors include inadequate stretching, prior muscle injury, and advanced age.
The athlete feels a sudden sharp pain on the medial aspect of the proximal gastrocnemius. It is painful to ambulate and plantar flexion is uncomfortable. On exam, the proximal medial calf is tender, and may be swollen and bruised. Walking on tiptoes is possible, but uncomfortable. The history is similar to that of Achilles tendon rupture, but the pain and tenderness are more proximal, and the Thompson test is negative in patients with gastrocnemius muscle rupture. Rupture of a Baker cyst should also be considered in the diagnosis, along with deep vein thrombosis.
Treatment typically consists of immobilization with a posterior splint, crutches for ambulation, ice, and pain medications. A mild rupture may be treated simply with rest and non-weight bearing.
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